Provider Demographics
NPI:1073575825
Name:EAR, NOSE, THROAT PHYSICIANS OF EASTERN KY
Entity Type:Organization
Organization Name:EAR, NOSE, THROAT PHYSICIANS OF EASTERN KY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SURI
Authorized Official - Middle Name:
Authorized Official - Last Name:VANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-432-0111
Mailing Address - Street 1:PO BOX 2140
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2140
Mailing Address - Country:US
Mailing Address - Phone:606-432-0111
Mailing Address - Fax:606-432-4272
Practice Address - Street 1:1330 S MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2321
Practice Address - Country:US
Practice Address - Phone:606-432-0111
Practice Address - Fax:606-432-4272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34477207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64344773Medicaid
KY000000219680OtherANTHEM BLUE CROSS
WV3810002865OtherWV MEDICAID
KY64344773Medicaid